The PEPPI study will improve screening for preeclampsia in pregnant womenPreeclampsia is one of the leading causes of morbidity and mortality in pregnant women and newborns worldwide. The risk of developing preeclampsia can be reduced by means of aspirin treatment. Since the early detection of risk groups is essential, screening for preeclampsia is now being developed through research.
Writer: Jaana Nevalainen
Preeclampsia is a pregnancy-related disorder characterised by high blood pressure and high levels of protein in urine after 20 weeks of pregnancy. Other symptoms include, for example, abdominal pain, swelling, headache, and vision problems. There is a risk of preterm birth due to the condition of the mother or the foetus, wherefore a more careful monitoring of pregnancy is required. The symptoms of preeclampsia can be alleviated by means of blood pressure medication and rest, but giving birth is the only cure.
In Finland, preeclampsia affects approximately 2–3 percent of pregnant women. In most cases, the disorder is mild. Annually, some 500 women develop a severe form of preeclampsia, resulting in a significant risk for the health of the mother and the baby.
Currently, preeclampsia screening in Finland is based on the mother’s medical history. Approximately 40 percent of pregnant women who will develop preeclampsia can be identified on the basis of their medical history. This means that the majority of preeclampsia cases occur in pregnant women with no identified risk factors. So, more information is needed for better detection of risk groups. Initiating aspirin treatment at an early phase may significantly reduce the risk of preeclampsia.
The PEPPI study will provide more information about risks
In Finland, the screening programme for preeclampsia is being developed through the PEPPI (Placental growth factor [PLGF] in Early Prediction of Preeclampsia and Placental Insufficiency) study. In the PEPPI study, the risk of preeclampsia is evaluated on the basis of maternal characteristics, that is, medical history and blood pressure, and a blood test taken during the first trimester of pregnancy. Globally, research has shown that this type of screening facilitates the detection of up to 70 percent of women at risk of preeclampsia.
The PEPPI study investigates if those women who are identified as being in the risk group through screening during the first trimester would benefit from a more careful monitoring of pregnancy, including blood testing and ultrasound examination in weeks 30–32 of pregnancy. Moreover, the study explores the impact of the mother’s pregnancy-related medical conditions and the father’s characteristics on the long-term health of the newborn child. Another aim is to study the feasibility of the screening programme for the detection of other pregnancy complications, such as intrauterine growth restriction and risk of preterm birth. One important aim of the PEPPI study is to clarify the effect of the mother’s iron deficiency (anaemia) during pregnancy on the short and long-term health of the mother and the child.
The PEPPI study is being conducted through collaboration between the University Hospital of Oulu and the child health clinics of the City of Oulu. The study started in spring 2022 at the Kontinkangas child health clinic in Oulu, and in autumn 2022 it will cover a total of 9–10 child health clinics in Oulu. Altogether 3,000 mothers are invited to take part in the study, together with the newborn babies and their fathers.
More information about the PEPPI study (in Finnish): www.peppitutkimus.fi
MD, PhD, Adjunct Professor Jaana Nevalainen is working as a Specialist in Obstetrics and Gynaecology at the University Hospital of Oulu. Her research focuses on the early detection of pregnancy complications related to placental insufficiency. She carries out research alongside her regular clinical work and during research leaves facilitated by grant funding provided by, for example, the Sakari Alhopuro Foundation.
A Current Care Guideline on Hypertension in Pregnancy and Preeclampsia, compiled by the Working Group appointed by the Finnish Medical Society Duodecim and the Finnish Gynaecological Association. Helsinki: Suomalainen Lääkäriseura Duodecim, 2021. Available online (in Finnish): www.kaypahoito.fi